Comparison of Two Manual Therapy Techniques in Patients with Carpal Tunnel Syndrome: A Randomized Clinical Trial

Background: Manual therapy techniques are part of physiotherapy treatment of carpal tunnel syndrome (CTS) which are classified into two groups including nerve mobilization and mechanical interface mobilization. The aim of the study was to find which manual therapy method-technique directed to mechanical interface and nerve mobilization–has superior beneficial effects on clinical and electrophysiological findings in conservative management of patients with CTS. Methods: Thirty patients with CTS participated into two groups namely: mechanical interface and nerve mobilization in this randomized clinical trial. The intervention was performed three times weekly for 4 weeks. Mechanical interface mobilization was directed to structures around the median nerve at the forearm and wrist. Techniques of median nerve gliding and tension were used in the nerve mobilization group. The outcome measures included visual analogue scale (VAS), symptom severity scale (SSS), hand functional status scale (FSS) and motor and sensory distal latencies of median nerve. Paired t-test and ANCOVA were used for statistical analysis. Results: At the end of the 4th week of the treatment, the mean of VAS, SSS and FSS significantly improved in both groups (p<0.05), but the difference was not significant between the two groups (P>0.05). Although the mean of motor and sensory distal latencies of median nerve at the end of the treatment period only improved in the nerve mobilization group (p<0.05), the difference was not significant between the two groups (P>0.05). Conclusion: Mechanical interface mobilization and nerve mobilization techniques are not superior to each other in reducing pain and improving hand symptoms and functional status

Manual therapy in the treatment of carpal tunnel syndrome in diabetic patients: A randomized clinical trial

Background: Generally, conservative interventions including physiotherapy modalities and manual therapy have been recommended in the management of carpal tunnel syndrome (CTS), but this subject has not been studied in diabetic patients with CTS. Therefore the aim of this study was to investigate the effects of manual therapy on diabetic patients with CTS. Methods: Thirty diabetic patients with CTS were randomly divided into two equal groups: modality group and manual therapy group. Participants in the modality group received transcutaneous electrical nerve stimulation (TENS) and therapeutic ultrasound (US) and patients in the manual therapy group received manual techniques for the median nerve and its surrounding structures. Interventions were applied 3 times weekly for 4 weeks in both groups. Visual analogue scale (VAS), symptom severity scale (SSS), functional status scale (FSS) and median neurodynamic test (MNT) were evaluated before and after the interventions in both groups. Paired t-test and independent t-test were used for statistical analysis. Results: Paired t-test revealed that all of the outcome measures had a significant change in the manual therapy group, whereas only the VAS and SSS changed significantly in the modality group at the end of 4 weeks. Independent t-test showed that the variables of SSS, FSS and MNT in the manual therapy group improved significantly greater than the modality group. Conclusions: Manual therapy techniques applied to mechanical interface of the median nerve and nerve mobilization possess more appropriate and valuable effects on hand difficulties than modalities in diabetic patients with CTS

The effect of item analysis in improving learning of kinesiology and biomechanics course

Background: Item analysis is an integrate component of course assessment which helps to improve the quality of the course exam and provide a guide for improving the teaching method. Increased quality of exam and teaching seem to have an important role in students’ learning outcome, as recommended in education for many years. The purpose of this study was to determine the effect of item analysis in improving students’ learning. Methods: Item characteristics of the multiple-choice questions (MCQs) in final exam for kinesiology and biomechanics of lower extremity course for physiotherapy students in winter semester of 2011who received routine teaching were studied. Improved and good MCQs were then conducted and together with an improved teaching applied for the same course in winter semester of 2012. The mean scores and number of students who passed the final exam in two studied semesters were compared to observe any effect of good MCQs and teaching on learning outcomes. Results: The good MCQs along with the improved teaching, is significantly associated with the greater mean score than in routine teaching and MCQs. The number of students who passed the exam did not differ between the two semesters. Conclusion: We conclude from these results that the item analysis serves as an effective educational tool which guides to revise test and improve teaching. On the basis of follow-up teaching and assessment, it appears that increased mean score in winter 2012 semester is associated with improved MCQs and teaching method and therefore possibly with an improvement in students’ learning. Key words: Item analysis; learning outcome; teachin

The Effect of Neuromobilization on Clinical Findings in Patients with Carpal Tunnel Syndrome

Objective: Neuromobilization techniques have been recently put forward in physiotherapy of carpal tunnel syndrome. The aim of this study was to assess the effect of neuromobilization on different aspects of evaluation including subjective, physical, and electrophysiological findings in CTS. Materials & Methods: In this randomized clinical trial study, 20 patients with carpal tunnel syndrome (32 hands) were assigned into two groups treatment and control group. In both groups, the patients received the physiotherapy modalities including the rest splint, TENS, and therapeutic ultrasound for 4 weeks. In addition to the physiotherapy modalities, the patients in treatment group received the neuromobilization techniques. The symptoms severity scale, visual analogue scale, functional status scale, Phalen's sign, median nerve tension test, and median nerve sensory and motor distal latency were assessed. Data were analyzed by Kolmogrolf-Sminolf, Paired T and Independent T and Mc nemar tests. Results: There was a significant improvement in symptoms severity scale, visual analogue scale, median nerve tension test, and Phalen's sing in both groups (P<0.05). However, the functional status scale (P0.05), except that the median nerve tension test (P<0.001) and functional status scale (P=0.004) was improved in the treatment group (P=0.023). Conclusion: Physiotherapy modalities and neuromobilization itself have positive effects on hand symptoms and the finding of physical examination. Thus, we suggest adding the neuromobilization techniques into the physiotherapy modalities in patients with carpal tunnel syndrome

Item Analysis an Effective Tool for Assessing Exam Quality, Designing Appropriate Exam and Determining Weakness in Teaching

Introduction: Item analysis is an integrate component of course assessment which helps observe the item characteristics and improve the quality of the course exam. It also provides a guide for improving the teaching method to enhance the students’ learning outcomes. However, item analysis results may not be applied to adjust the way teachers teach and improve the items characteristics. The purpose of this study was to determine the effect of item analysis in improving assessment and teaching quality. Methods: The Item characteristics of the final exam for kinesiology course for physiotherapy students in 2 semesters were studied. Improved and good multiple choice questions (MCQs) were then conducted for another semester, followed by application of both good MCQs and improved teaching for the other semester. The item characteristics were compared to observe any effect of good MCQs and teaching on educational performance. Results: The good MCQs along with the improved teaching were associated with the greater mean score and the students who passed the exam rather than those with only good MCQs. The percentage of easy questions (42.5%) in students who received good MCQs and improved teaching compared with those (15%) who only received good MCQs indicated that the improved pool of questions were shifted from medium to easier questions. Conclusion: We concluded that the item analysis should be followed by revised and improved teaching method. It appears that improved item characteristics are associated with improved teaching method and possibly with an improvement in students’ learning

Using Log Book in Clinical Education of Physiotherapy Students

Introduction: Clinical education plays an important role in medical education, in which students learn new skills and obtain knowledge of their usage in patients. Log book, as an evaluation tool, can be used to improve the clinical education levels as well as educational planning and evaluation process. Since there is no study about the usage of log book in clinical education of physiotherapy students in Iran, and due to the incomplete studies on log book usage in other disciplines, our study aimed at using log book in clinical education of physiotherapy students with the emphasis on the content of log book. Methods: Twenty four undergraduate semester 7 physiotherapy students, who have already experienced the routine clinical education, were selected using convenience sampling. The students were allocated randomly into 4 clinical education centers affiliated with the Faculty of Rehabilitation. They were educated and evaluated for the whole semester by using log book. A valid and reliable written questioner in different educational domain was used for analysis. Results: In this preliminary study, our finding following the intervention (log book) demonstrated descriptively. The study results showed that among 23 analyzed educational items, the students&rsquo; most satisfactions by using log book obtained from the education of physiotherapy recording manner, documentation of experience and their possible comparison in different semesters, improvement of self-evaluation spirit, and systematic recording of educational tasks. Conclusion: Log book in clinical education of physiotherapy students can be used as an effective tool in improvement of the quality of clinical education